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Michael Wagner
NPI 1336655034 · on the registry since 2017 · sole proprietor
Practice
- Address
- 807 Pine Ave Nw
Grand Rapids, MI 49504 - Phone
- (616) 776-7094
- Fax
- (616) 776-7094
Registry record
- Primary taxonomy
- Adult Care Home Facility
311ZA0620X
- Licence states on file
- MI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2017-12-18
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan